Hsu H C, Wu T T, Wu M Z, Sheu J C, Lee C S, Chen D S
Department of Pathology, College of Medicine, National Taiwan University, Taipei, Republic of China.
Cancer. 1988 May 15;61(10):2095-9. doi: 10.1002/1097-0142(19880515)61:10<2095::aid-cncr2820611027>3.0.co;2-h.
In order to elucidate the biologic behavior of hepatocellular carcinoma (HCC), the long-term prognostic impact of the pathologic features of 143 surgically resected HCC were studied. Seventy-four were smaller than 5 cm in diameter (small HCC), and 69 were larger (large HCC). This study confirmed that tumor size was an important but not the only determining prognostic factor in HCC. Although cirrhosis could cause hepatic failure, patient mortality was mainly attributable to tumor recurrence, which, in turn, was strongly correlated with the invasive nature of HCC. Tumor invasion to the liver and the intraportal spread were very frequent and particularly extensive in large HCC. In both small and large HCC the noninvasive groups not only had high 4-year actuarial survival (84.6% and 90%, respectively), but there was also no patient mortality from intrahepatic tumor recurrence. Therefore, it was concluded that invasiveness of an HCC is the most crucial factor in determining the long-term outcome for the patient, and that the clinical course of resected HCC is predictable in a great majority of the cases. In our small HCC series only 2.4% of HCC were regarded as having true multicentric origin. These findings suggest that the majority of HCC occur unicentrically, and that multiplicity and tumor recurrence result mostly from intrahepatic dissemination. In both small and large HCCs invasive tumors were accompanied by high patient mortality from tumor recurrence even when the tumor was small, indicating that intrahepatic spread may start very early during the growth of HCC.
为了阐明肝细胞癌（HCC）的生物学行为，我们研究了143例手术切除的HCC病理特征对长期预后的影响。其中74例直径小于5cm（小肝癌），69例直径大于5cm（大肝癌）。本研究证实，肿瘤大小是HCC重要的预后决定因素，但不是唯一因素。虽然肝硬化可导致肝衰竭，但患者死亡主要归因于肿瘤复发，而肿瘤复发又与HCC的侵袭性密切相关。肿瘤侵犯肝脏和门静脉内播散在大肝癌中非常常见且尤为广泛。在小肝癌和大肝癌中，非侵袭性组不仅4年实际生存率高（分别为84.6%和90%），而且没有患者因肝内肿瘤复发死亡。因此，得出结论，HCC的侵袭性是决定患者长期预后的最关键因素，并且在大多数情况下，切除的HCC临床病程是可预测的。在我们的小肝癌系列中，仅2.4%的HCC被认为具有真正的多中心起源。这些发现表明，大多数HCC为单中心发生，并且多灶性和肿瘤复发主要源于肝内播散。在小肝癌和大肝癌中，侵袭性肿瘤即使肿瘤较小也伴有较高的肿瘤复发患者死亡率，这表明肝内播散可能在HCC生长的早期就开始了。
